tbuckley/cabot-search huggingface dataset:
Abstract 131: Perceived Exertion And Physical Demand Of Performing 10-minutes Of Compression-only CPR
Authors: Kate Flickinger, Ryann DeMaio, Peter Prescott, Alexandra Weissman, David D Salcido, Patrick J Coppler, Cecelia R Ratay, Elizabeth Nagle, Jon Rittenberger, Fredric Goss, Clifton W Callaway, James J Menegazzi
Journal: Circulation (2022)

Cardiopulmonary resuscitation (CPR) is physically demanding and must also be performed under emotional distress. Most cardiac arrests (CA) occur at home, making it likely that only one rescuer is available to perform CPR until emergency medical services (EMS) or other lay rescuers arrive. We performed a study to quantify the physical exertion required of lay-providers performing compression-only CPR for 10 minutes both with (WFB) and without (WOFB) real-time CPR quality feedback. We recruited healthy, CPR certified lay individuals to perform 10-minute rounds of CPR on two occasions: once WFB and once WOFB. We collected heart rate (HR), oxygen consumption (VO 2 ), and rating of perceived exertion (RPE) at baseline and throughout each round of CPR and collected capillary lactate and blood pressures pre- and post-CPR. We used Kruskal Wallis, Wilcoxon signed rank and rank sum tests to compare changes in measures during CPR. Participants were 15 females and 11 males, age 25 (IQR 22-37). All measures except for diastolic blood pressure, significantly changed over time. Systolic blood pressure increased both WFB (mean difference (MD) 8mmHg; 95% CI 12-5) and WOFB (MD 8mmHg; 95% CI 12-3). VO 2 and HR increased over time, but peak VO 2 and HR did not differ by group. RPE significantly increased WFB and WOFB (WFB MD 8; 95% CI 10-7; WOFB MD 8; 95% CI 9-7) WFB and WOFB, with females reporting a higher RPE immediately post-CPR WFB than males (MD 2; 95% CI 5-1). Lactate increased from baseline immediately post (WFB MD 2.3mmol/L; 95% CI 0.9-3.7; WOFB MD 1.8mmol/L; 95%CI 2.6-1) and 5-minutes post CPR (WFB MD 0.8mmol/L; 95% CI 2.3-0.7; WOFB MD2.1 mmol/L; 95% CI 0.9-3.3). CPR produces subjective and objective signs of strenuous exertion in both men and women. The presence of feedback does not alter physiologic response to prolonged CPR. However, females reported higher RPEs when performing CPR WFB, despite no significant difference in physiologic response.
Abstract 13029: Acute Myocardial Infarction - Mortality Trends in the United States
Authors: Muhammad Tayyeb, Mohsin S Mughal, Hasan Mirza, Muhammad Asif, Seemab Fatima, Ali Ghani, Fahad Waqar, Waqar A Mughal, najam wasty
Journal: Circulation (2022)

Introduction: Acute Myocardial Infarction (AMI) contributes to a significant cardiovascular related deaths in the general population. AMI is a life-threatening condition that occurs when the blood supply to the myocardium is abruptly cut-off due to blockage in coronary arteries resulting in tissue infarction. AMI is associated with high morbidity and mortality (up to 34-42%). We hypothesized that with recent advancements in reperfusion therapy and techniques for treating arrhythmias and pump failure, the mortality rates might show downward trends. Methods: In this retrospective observational study, death certificate data was retrieved from the Center for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiological Research (WONDER) database from 2001 to 2020. WONDER database identifies the underlying cause of death. Mortality for AMI including anterior, posterior, inferior wall, or unspecified (ICD-10 121.0; 121.1; 121.2; 121.3; 121.4; 121.9) as an underlying cause of death was queried from 2001 to 2020. This study duration was further divided into five-year periods. Crude mortality rate and age-adjusted mortality rate per 100,000 deaths (with a 95% confidence interval) were calculated for four U.S. census regions to explore regional variations (CR-1 Northeast; CR-2 Midwest; CR-3 South; CR-4 West). Results: The overall age-adjusted mortality rate (AAMR) decreased from 58.0 to 27.1 per 100,000 deaths (53.5%) in the years 2001-2005 to 2016-2020 as illustrated in the figure 1. AAMR showed a comparable downward trend in all 4 U.S. census regions (Figure 1). Conclusions: From 2001 to 2020 AAMR showed a downward trend which may indicate an improvement in AMI patient care with evolving guidelines based therapeutic interventions. Limitations of this study include intrinsic weakness of the WONDER dataset (Changes with ICD-9 to ICD 10 codes, and potential miscoding) which may need further discovery.
Abstract 13809: Multiparametric CMR Tissue Characterization Distinguishes Pathological From Physiological Cardiac Hypertrophy and Correlates With CPET Findings
Authors: Andrea Coy-Cangucu, Layde Paim, Luís M Da Silva, Adriana Aparecida Bau, Camila N Martins, Lígia Antunes-Correa, Andrei Sposito, Wilson Nadruz, Tomas G Neilan, Michael Jerosh-Herold, Otavio R Coelho-filho
Journal: Circulation (2022)

Introduction: Physiological and pathological cardiac hypertrophy differ in terms of mechanisms, phenotypes, and outcomes. We aimed to characterize the cardiac tissue phenotype of athletes and HF patients. Methods: Prospectively enrolled participants underwent CMR and CPET. HF patients (NYHA class II-III) were classified as HFpEF (LVEF&gt;=45%) or HFrEF (LVEF&lt;45%). Results: One-hundred and eighty participants were categorized in four groups: athletes (n=44, 32±12 years), HFpEF (n=47, 61±11 years, H2FPEF score 5±2), HFrEF (n=47, 54±10 years), and healthy controls (n=42, 41±13 years). LVEF was markedly reduced in HFrEF (athletes 65±6%, HFpEF 59±11, HFrEF 29±9, controls 66±4, p&lt;.001). LV mass index (athletes 65±6%, HFpEF 59±11, HFrEF 29±9, controls 66±4, p&lt;.001) and cardiomyocyte mass index (athletes 64±15g/m 2 , HFpEF 66±24, HFrEF 82±36, controls 42±8, p&lt;.001) were greater in athletes and in HF patients (Fig 1A). Athletes and HFpEF patients had concentric LV remodeling, while HFrEF patients showed eccentric remodeling (Fig 1B). Intracellular lifetime of water was longer in athletes and shorter in HFrEF (athletes .17±.07s, HFpEF .15±.05, HFrEF .13±.05, controls .14±.05, p&lt;.001) (Fig 2A). ECV was similarly increased in both HF groups (athletes .28±.04%, HFpEF .31±.05, HFrEF .31±.05, controls .28±.04, p&lt;.001) (Fig 2B). Native T1 (athletes 1175±55ms, HFpEF 1261±61, HFrEF 1274±61, controls 1229±75, p=.01) correlated with CPET maximal oxygen consumption (VO 2 max) in HF patients (r=-.023, p=.048) (athletes 52±10, HFpEF 18±6, HFrEF 17±4, controls 29±9, p&lt;.001). Conclusion: Physiological hypertrophy was characterized by increased cardiomyocyte diameter, normal ECV, and shorter native T1 due to its greater cardiomyocyte volume. Contrastingly, pathological hypertrophy’s longer native T1 was a result of its higher ECV and correlated with VO 2 max in HF. Cardiomyocyte diameter was smaller in HFrEF than in HFpEF.
Abstract 13168: Benefits of Apixaban Over Warfarin are Preserved Independent of Warfarin Time in Therapeutic Range: Insights From the AUGUSTUS Trial
Authors: Josephine Harrington, Anne S Hellkamp, John H Alexander, Roxana Mehran, Christopher B Granger, Shaun G Goodman, Ron Aronson, Stephan Windecker, Renato D Lopes
Journal: Circulation (2022)

Introduction: In the AUGUSTUS trial, patients randomized to apixaban had lower rates of major or clinically relevant non-major (CRNM) bleeding, lower rates of death or hospitalization, and similar rates of death or ischemic events compared with warfarin. Patients randomized to aspirin (ASA) had higher rates of bleeding with similar rates of death or hospitalization, and death or ischemic event. The impact of warfarin time-in-therapeutic-range (TTR) on these outcomes is not known; however, it is plausible that sites achieving better TTR might have better outcomes with warfarin use. Methods: Using average site TTR, we assessed the hazard of bleeding, ischemic events, and death/hospitalization across quartiles of site-based TTR. These analyses were performed for both randomized strategies: apixaban vs warfarin and ASA vs placebo. Results: This analysis included data from 4420 patients at 399 sites. Site TTR was separated into quartiles of TTR (Q1: 0-49%, Q2: 42-55%, Q3: 56-69%, Q4: 70-100%). Sites with higher TTR tended to have fewer female patients (32.4% Q1 vs 25.4% Q4), more White patients (88.5% Q1 vs 97.1% Q4), and more patients previously prescribed oral anticoagulants (44.5% Q1 vs 52.5% Q4). There was no significant interaction between site TTR quartile and the hazard ratio (HR) for bleeding, death or hospitalization, or death or ischemic event with apixaban vs warfarin, or on the HR for bleeding, or death or hospitalization with ASA vs placebo (Figure). There was a borderline significant interaction (p&lt;0.047) between site TTR quartile and the HR for death or ischemic events with ASA vs placebo, such that patients at sites with higher TTR were more likely to derive a benefit from ASA compared with placebo. Conclusion: The benefits of apixaban over warfarin seen previously in AUGUSTUS are consistent across the spectrum of quartiles of site TTR. Patients at sites with higher average TTR may be more likely to derive a benefit from aspirin use to prevent death or ischemic events.
Abstract 14091: Severe Hypothyroidism Revealing Hidden Tracts
Authors: arushi sharma, shanil shah, Shihla Shireen Kanamgode, Nilesh Kumar, Madhurima Home
Journal: Circulation (2022)

Discussion: Atrioventricular reciprocating tachycardia (AVRT) is a type of Supraventricular tachycardia (SVT) caused by an accessory pathway can result in symptomatic and also life-threatening arrhythmias. Supraventricular tachycardias are less commonly seen in hypothyroidism than hyperthyroidism. We present a case of a 41 year old gentleman who presented with chest pain and SVT was found to have severe hypothyroidism with pre-excitation pattern on his EKG. Case: 41-year-old Caucasian gentleman with history of untreated Hashimoto’s thyroiditis presented with palpitations and acute onset left-sided chest pain. His symptoms were aggravated with movement and improved with rest. When EMS found him, his vitals were significant for tachycardia with a heart rate (HR) of 200 beats per minute (bpm). EKG showed supraventricular tachycardia. Vagal maneuvers were attempted followed by adenosine. This resulted in conversion to sinus rhythm and improvement in HR to 88 bpm. His chest pain completely resolved. He was then brought to the emergency room where he had normal vitals. Examination revealed thyroid gland was palpable and noted to be diffusely enlarged. Laboratory data was significant for an elevated thyroid-stimulating hormone (TSH) of 373 mIU/ml and undetectable free thyroxine (fT4) levels. His creatinine kinase (CK) was high at 16260, and troponin was elevated at 0.220 ng/ml (reference:&lt;0.04 ng/ml). TPO antibodies were &gt;600 IU/ml. EKG demonstrated sinus rhythm with pre-excitation and incomplete left bundle-branch block. He had normal chest x-ray. An echocardiogram showed an ejection fraction of 55% with mild LV diastolic dysfunction. He later underwent a stress myocardial perfusion scan which showed no definite evidence of inducible ischemia. Follow up: He was started on thyroxine replacement therapy. He is due for an EP study to evaluate for an accessory pathway causing pre-excitation with repolarization pattern on his ECG. Conclusion: This case suggests that severe hypothyroidism can also cause supraventricular tachycardias (SVT) by metabolic and conduction derangements revealing concealed bypass tracts in patients with accessory pathways. In most cases these arrhythmias are reversible once the underlying thyroid disorder is treated.
Abstract 14072: Heart Retransplantation Under the 2018 Adult Heart Allocation Policy
Authors: Samuel T Kim, Mark Helmers, Amit Iyengar, D. Alan Herbst, Noah Weingarten, Pavan Atluri
Journal: Circulation (2022)

Introduction: The new adult heart allocation policy was implemented on October 18, 2018. The purpose of the present study was to characterize the impact of this policy change on waitlist and post-transplant outcomes of heart retransplantation in the United States. Methods: All adults listed for heart retransplantation from May 2015 to March 2022 were identified using the United Network for Organ Sharing database. Patients were stratified into equal time eras (pre- and post-policy) based on the heart allocation change on October 18, 2018. Competing risks regressions were used to determine differences in waitlist outcomes, including waitlist death or deterioration and retransplantation rates following listing. Kaplan-Meier survival estimates were used to assess differences in 1-year post-transplant survival between eras. Results: Overall, 672 heart transplant candidates were included in analysis, with 49% listed during post-policy. Retransplantation candidates listed during post-policy were of similar age (45 vs 47 years, P=0.11) and female gender (33% vs 34%, P =0.70) compared to pre-policy candidates. Post-policy candidates had a shorter median waitlist duration (51 days vs 80 days, P&lt;0.01), along with a lower likelihood of death or deterioration on the waitlist (subdistribution hazard ratio, SHR 0.45, 95% CI 0.27-0.74) and higher likelihood of retransplantation within 30 days of listing (SHR 2.65, 95% CI 1.86-3.80) compared to pre-policy (Figure). Among those retransplanted, pre-policy recipients experienced similar rates of 30-day post-transplant mortality (6.9% vs 6.7%, P=1.00) and 1-year post-transplant survival (82% vs 87%, P=0.24). Conclusions: Heart retransplantation candidates have experienced improved waitlist outcomes following the 2018 adult heart allocation policy without significant changes to post-transplant survival. Continued monitoring for long-term outcomes is warranted in this patient population.
Abstract 14354: Prognostic Impact of Low Serum Chloride Level in Elderly Patients With Heart Failure
Authors: Shota Shirotani, Kentaro Jujo, Makoto Kishihara, Shonosuke Watanabe, Takuma Takada, Takuro Abe, Junichi Yamaguchi
Journal: Circulation (2022)

Background: Patients with heart failure (HF) are known to be stratified the risk of mortality by serum chloride level. However, since large-scaled studies to date have not included the elderly patients, it is still unclear whether serum chloride level well predicts the prognosis of the elderly patients with HF, whose clinical profiles are different from young adult patients. We aimed to test the hypothesis that hypochloremia gave different prognostic impacts in non-elderly and elderly patients with HF. Methods: This observational study included 1,326 elderly patients ( &gt; 65 year-old) without regular hemodialysis who were hospitalized for worsening of HF and discharged alive. They were divided into two subgroups depending on serum chloride levels at admission (Low-chloride group ( &lt; 97 mEq/L, n=244); Normal-chloride group ( &gt; 98 mEq/L, n=1518)), referred to prior reports. Propensity scores were developed and patients in Normal-chloride group were matched with those in Low-chloride group in a 1:1 ratio. The endpoint of this study was death from any cause. Results: Among 1,326 unmatched patients, Low-chloride group included significantly more male patients, and those with higher BUN, CRP, bilirubin levels, dose of furosemide and atrial fibrillation, and prescriptions of oral anticoagulant, and lower BMI, blood pressure, hemoglobin, prescription of mineral corticoid receptor antagonist, thiazide and statins. Following propensity score matching by diverse baseline parameters, 106 pairs in both groups were included in the matched population. During 413 days of median observational period, 62 patients (28.8%) died. Kaplan-Meier analysis showed that patients in the Low-chloride group had a significantly higher mortality rate (p=0.011, Figure ). Conclusion: In this observational study, baseline hypochloremia was associated with an increased mortality in elderly patients hospitalized with heart failure.
Abstract 13007: Assessing Patient Engagement With a Mobile Health Application for Self-Care Of Heart Failure in a Real-World Setting
Authors: Ifeanyi Madujibeya, Terry Lennie, Jamie Pelzel, Debra K Moser
Journal: Circulation (2022)

Background: Consumer-facing mobile health applications (mHealth apps) are being increasingly integrated into routine heart failure (HF)-related self-care. However, there is a dearth of research on patient engagement with consumer-facing mHealth apps in real-world settings and the effect of such engagement on HF outcomes. Objectives: This study examine the patterns of patient engagement with a consumer-facing mHealth app,and the effects of engagement on HF outcomes. Method: This was a longitudinal observational study of patients who used a consumer-facing mHealth app, OnTrack to Health, for self-care of HF in a real-world setting between 2012 and 2020. Patient engagement was assessed as the percentage of assigned self-care activities checked off and transmitted daily to the nursing team via the app interface, within the first 575 days of use. Bilinear spline growth models were used to examine patterns of patient engagement during free subscription and post-free subscription periods and to determine the predictors of the engagement. The effects of patient engagement on medication adherence were examined using linear mixed effect models. Results: A total of 229 participants (148/229, 64.6% male), with a mean age of 62.2 (SD 14) years used the app. The mean (SD) daily patient engagement and medication adherence were 77.3 (27.5)%, and 98.4 (3.7)%, respectively. Patient engagement with OnTrack to Health app decreased overtime during the free subscription (β -.490, 95% CI -0.796 to -0.184, P = .002 ) and post-free subscription patient engagement(β -.567, 95% CI -0.860 to -0.272, P &lt;.001) periods, attainment of target doses of guideline-directed medical therapy (β .002, 95% CI 0.001 to 0.003, P &lt;.001), and being a long-term vs. short-term app user (β .191, 95% CI 0.063 to 0.319, P =.003) were associated with a higher rate of patient engagement over time. Patient engagement was not significantly associated with the rates of changes in medication adherence over time (β .002, 95% CI -0.003 to 0.007, P= .360) Conclusion: The declining trend of patient engagement with consumer-grade apps, indicates a need for effective strategies to sustain patient engagement, and such strategies may include financing models that place no or minimal financial responsibility on patients.
Abstract 12779: Serial High-Sensitivity Troponin I and Long-Term Risk of Death in Subjects With Suspected Acute Coronary Syndrome
Authors: Manan Pareek, Kristian Kragholm, Anna Meta Kristensen, Tor Biering-Srensen, Christina Byrne, Emil L Fosbol, Lars Kober, Gunnar Gislason, Niels T Olsen, Deepak L Bhatt, Christian Torp-Pedersen
Journal: Circulation (2022)

Introduction: Long-term prognostic implications of serial high-sensitivity troponin concentrations in subjects with suspected acute coronary syndrome (ACS) are unknown. Hypothesis: To determine mortality according to high-sensitivity troponin I (TnI) concentrations and their changes from baseline, in patients with suspected ACS. Methods: Using Danish registries, we identified individuals with a first diagnosis of myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019 who underwent two high-sensitivity TnI (Siemens TnI Flex® Reagent, 99 th percentile 45 ng/l) measurements during the same hospitalization. Prognostic implications of serial sampling were examined stratifying subjects for normal and elevated concentrations, and for relative changes of 20% and 50%. Absolute and relative risks for death from any cause at days 0-30 and 31-365 were calculated through multivariable logistic regression with average treatment effect modeling. Results: Of the 20,609 individuals included, 2.3% had died at 30 days, while 4.7% of 30-day-survivors died between days 31-365. The standardized risk of death at both 0-30 and 31-365 days was highest among subjects with two elevated TnI concentrations (0-30 days: 8.0%, 31-365 days: 11.1%) and lowest among those with two normal TnI concentrations (0-30 days: 0.5%, 31-365 days: 2.6%). In neither case did relative changes between measurements clearly affect mortality. Nevertheless, among persons who went from a normal to an elevated TnI concentration, 30-day mortality was highest in those with a &gt;50% rise versus subjects with a less pronounced rise (2.2% vs. &lt;0.1%). The Figure shows the standardized absolute risk of death from any cause from days 31-365. Conclusions: Among individuals with suspected ACS, those with two elevated TnI concentrations consistently had the highest risk of death. Mortality was very low in subjects with two normal TnI values.
Abstract 14078: Exercise Pulmonary Impedance and Coupling Stress Test, and MRI-Based Regional Strain Analysis: Identifying Afterload-Sensitive Phenotypes in PH-HFpEF
Authors: Farhan Raza, Christopher Lechuga, Daniel Seiter, Claudia E Korcarz, Marlowe Eldridge, Prashant Nagpal, David Bluemke, Oliver Wieben, Naomi Chesler
Journal: Circulation (2022)

Objectives: In pulmonary hypertension associated with HFpEF (PH-HFpEF), identifying mechanisms of right ventricular: pulmonary arterial (RV:PA) uncoupling can be leveraged for sub-phenotyping and targeted therapies. In this study, we aim to distinguish mechanisms of RV:PA uncoupling in PH-HFpEF due to high RV afterload (afterload-sensitive; AS) and impaired left ventricular-interventricular septal contributions to RV function (ventricular interdependence; VI). Methods: Subjects (n=13) with early-stage PH (per echo) and NYHA II-III dyspnea were prospectively enrolled. Exclusion criteria: advanced disease with NYHA IV, LVEF &lt;50%. All subjects underwent rest-to-exercise (every 25 watts) invasive cardiopulmonary exercise test and echo (for impedance: characteristic for pulsatile load Z C , input for steady load Z 0 ), followed by RV real-time pressure volume (PV)-loops. Subsequently, a cardiac MRI was performed with temporal resolution of 25-30 msec. Five study subjects had isolated post-capillary (Ipc-PH), 5 had pulmonary arterial hypertension, 2 had combined pre/post-capillary PH, and 1 had no PH. Results: With exercise, impedance (Z C and Z 0 ) increased or remained unchanged in all PH subjects but decreased in the subject with no PH. Z C (time domain method) was correlated with PV-loop based uncoupling (end-systolic to elastance ratio Ees:Ea) among Ipc-PH subjects (r 2 =0.40, p&lt;0.01), but had poor correlation in other phenotypes (r2=0.01, p=0.11). As next step, within each IpcPH subject, correlation of Z C with Ees:Ea (with repeated measures across exercise stages) was determined to identify afterload sensitivity (Figure). Cardiac MRI-based regional strain was used to identify ventricular interdependence; defined as reduced strain of interventricular septum (Figure). Conclusions: Multimodality methods to assess RV:PA uncoupling in PH-HFpEF can identify afterload-sensitive phenotypes, which may benefit from focused interventions.